PRE 2010 DOCSSUBJECT
PER O.
City of Fridley
7 ®-
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECE
`v -.---- COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r � PROTECTIVE
1 �
= CITY HALL FRIDLEY 53432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
4/22/99
10B ADDRESS 4700 2 Street NE
I LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
14,15
5
I Plymouth Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Chuck Ostic 4700 2 Street NE
571-4950
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Norling Exteriors Inc 341 79 Way NE, Fridley, MAT
55432 784-8936
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
20098700
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
0 NEW 0 ADDITION 0 ALTERATION (j REPAIR 0 MOVE O REMOVE
8 DESCRIBE WORK
Reside House
9 CHANGEOFUSEFROM TO
STIPULATIONS a
Call for building wrap inspection before
covering.
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING,
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO DWLG. UNITS
OFFSTREET PARKING
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
ISTALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$7,200
@
$3.60
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING COW
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$137.25
Fi C $7.20
PLAN CHECK FEE
TOTA Fqt
Gtis
SC
$5
V53.05 .
SIGNATURE OF CONTRACTORORA TwORQED AGE T IDATEI
WHE PR
AL HIS IS Y
BL G IhSP
sPEAPA
®
GATE
S-GNATURE OF OWNERIIF OWNER BUILOERI IDATEI
NEW [ ] Effective 1/l/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 'a"57 -Ale- Fr, iclle, M., X-
ya4
Legal Description:
Owner Name & Address: v e k 0 Tel. # _ '11 - q f. ,p
Contractor: tuav--11 PI!2) (? }�-�� r �,,, � t MN LICENSE # f ro 9,9
Address: 3 q I W &_ rK n Vic( 3 Tel. # Y 3�_
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach td this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Construction Type: h -,c 5-1 de 6.o5 P Estimated Cost: $ % ,
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: V - D J, iq` APPLICANT: /' 06�'? n ( e 1)8 ' I r & ( Tel. # -S_/,_1, -1 2 -70
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]